My first days in the hospital I worked only during daylight hours to meet the local orders. The hospital needed a doctor so desperately that I was pressed into action even before all the formalities were finished. On my very first day I was invited by a chief security officer into a rather stark and bleak furnished office where he probed me for details about my life, education and even about my family.
— Were your parents ever convicted of a crime? — He inquired.
— No, — I answered. My parents were divorced when I was a child and I have not seen my father for years.
A few days later the same chief security officer called me again and said that I had deceived him. They had checked all the information and it turned out that my father had been adjudged guilty of petty theft and fined when he was young. I was surprised and had to write an explanatory letter assuring them that I did not know about it. They wanted to fire me at once but the head of the hospital said that they had an acute need for one additional doctor, so I continued to work. They also warned me that for my own safety I should not put it out on the internet or in any other way advertise that I was working in a prison. The fact is that prisoners have relatives and friends on the outside that could be angry with the penal system and want to take revenge on me as a part of it. They wouldn’t understand that my job was just to help my patients.
To reach the hospital in the center of prison I had to pass four checkpoints. On the first we were told to leave our phones and valuables. But when I went to I relinquish my phone, Olga, — the doctor who had invited me to work there — explained that I could simply say I had no phone with me. I should understand, however, that prisoners could steal my phone if they knew I had one. And of course I shouldn’t show it to guards, patients and orderlies.
At the second checkpoint I had to display my permit and go through a metal detector frame. I suppose that it must never have worked properly because I never once saw it react to our hidden phones, keys, or anything else. Beyond that point I as a woman, according to the rules, could not go any further, not even with other women. We were required to proceed only in the company of a man, even if there were several healthy women and only one man, weak and thin. We used to wait for a random companion near the door. There were also special duty prisoners who were called “runners”. They were assigned to accompany women workers in the territory of prison. The runners were respectful to us, but felt themselves privileged and could push or cry out to any sluggish prisoner who swept the concrete and did not immediately move aside to let us pass. So one of these runners or basically any other unoccupied man that could be found had to accompany me through the third and fourth checkpoints both of which looked like huge iron gates forever manned ‘on automatic’ by on-duty prisoners. It always seemed strange to me: prisoners are dangerous, so we have to follow the rules. And who protects us from the prisoners? Other prisoners.
Springtime inside the prison was radically different from out in the city. It seemed like you went from a disgustingly dirty world with piles of garbage on the bald lawns, mucky, cracked pavements and roads — to an opposite world of perfect cleanliness. You couldn’t see a single discarded cigarette butt or any sign of rubbish along the concrete paths; flowers were blossoming and every corner of the parade ground was in ideal condition. I thought it could be beautiful like a garden if there were less concrete and fewer walls. And if you saw different faces among the oncoming people — without those overly tense eyes and set expressions, almost like sallow implants, of a degrading life. One day it was raining, as often happens in the spring, and I saw the prisoners mechanically (and with what seemed a hint of melancholy) sweeping the area under the falling streams from the sky. They just had to do the cleaning constantly, even if it was useless or unpleasant in the moment.
Once a day Olga and I had a meal together in the canteen. There I would see a few civilian employees alongside several prisoners. These workers were all young guys, extremely polite in manner, agile and deft as they distributed the food. Had it not been for their clothes, you couldn’t have distinguished the free from the confined. Moreover, I was surprised that I could have a whole simple but tolerable dinner for just a few rubles. For this money outside I could buy only a half of loaf of bread. It seemed like time had stopped in here, and the epoch of Soviet Union -- when everything was cheap and looked like it had come off an assembly line – had never ended.
Very quickly I recognized that my academic knowledge didn’t fit to the reality of prison. One experienced surgeon — Anatoly, an old and kind alcoholic with an open smile — operated on a patient with a damaged foot. Anatoly was the main surgeon and I just helped him. He formed a very strange device of external fixation on the patient’s foot, but I said nothing in the operating room. When we came to the staffroom, I asked him:
— What a strange contraption you installed. They taught me that the parts of metal construction like arcs shouldn’t touch the swollen tissues because it could be a reason of necrosis. However your device just lies on his foot. He couldn’t recover in these conditions!
— You’ll see, — he answered confidently, — he will recover. You should consider that they are prisoners, so they live in extreme circumstances, where their bodies have to adapt and mobilize all their resources, like in a war. This metal construction could cause a necrosis in the any patient outside, but not here.
A few days later I was astonished to see that the edema on the patient’s foot had decreased and he was starting to recover. Then I watched how Anatoly prescribed to another patient after the dissection of an abscess not to take an antiseptic but to wash his wound with laundry soap. I was horrified. We live in the 21st century and the patient should use coarse industrial soap instead of medicine! Why?!
— We don’t have enough medicine, — answered the doctor calmly. — We even don’t have enough painkillers and antipyretics. Nothing other than our own chemicals is located in the prison’s territory, so it doesn’t have an address. And we can’t make an order like all the hospitals outside. This system is very difficult. Some drugs are delivered by patient’s relatives — with big delay every time, of course. Some drugs we ask our friends from other hospitals…
One nice morning I heard the head of the hospital, Valery, speaking into the phone to his old friend from the polyclinic:
— And please, guy, could you steal this drug for me? I have nothing to treat one patient…
At home I rummaged through my own first-aid kit, choose some medicines and brought them to our hospital nurse.
— Thank you very much! — She exclaimed.
— Mmm… I’m not sure if we could use these tablets, — I said honestly. — The expiration date has expired.
— Don’t hesitate, please, — she smiled. — Not so long ago. It is better to use them than use nothing.
Soon I had to get used to such conditions. Once I operated on a patient with bleeding from several small vessels. We didn’t have a special device for coagulation and it was not easy to stop the outflow of blood from his wound.
— Do you smoke? — I asked him.
— Yes, I do, — he muttered cautiously, thinking that now I will ban his only pleasure and orderlies won’t take him to smoke on the back porch. Without orderlies our patients were not allowed to leave their wards.
— Smoke more, — I advised. — It is necessary in order to narrow your vessels and stop the bleeding.
Could I ever have thought that one day I would recommend my patient to smoke more?!
To treat a cold and flu we had only the suggestion to drink a hot tea. However Olga said that it did not work.
— When the orderlies bring hot tea from the prisoner’s canteen, they at first go to their manager — he is a prisoner too, but he is a “thief in law” — very respectful person for them. By that time the tea turns cold.
— Can I ask them at first go to my patients? — I sought to clarify.
— Sure, you can, and they will agree, but will ignore your request. They have to bring tea first for the manager — it is a one of those strange prison laws. Don’t give them an obvious reason to disobey you.
I was silent for a few seconds and then changed the subject. I asked the question that I had been thinking about for all my first days.
— Tell me, please, how do you really treat them? On the one hand, they are dangerous people and we even have to examine our patients only in presence of orderlies who could protect us in an emergency. They are really killers, drug dealers and other deviant people who must be in the prison. On the other hand, we are not the ones who execute the punishment and our duty is to help people. Do you sympathize with them or not?
There was nobody in the staffroom except us. I just had brewed a tea for us from tea bags and we were sipping it looking out the window at the lilac bush and a bunch of prisoners smoking on the back porch. I was going to go home but Olga stayed for her night duty.
— It is a really difficult question, — she answered thoughtfully. — Of course, you should be cautious, but remember that one day you could go to a jail too. Not all of them are criminals and in our country nobody is insured against falling into a prison. Especially if you are a doctor. Recently one orderly was released. He was a brilliant neurosurgeon outside but here he just washed the floor and cleansed our scalpels. It happens. Somebody can find a reason to imprison every person whoever he or she is.
I remembered how I had made an illegal circumcision for two Muslim boys when I was a student. I just wanted to earn a little money to buy a pair of winter boots and thought that it would be better if that operation would be made by me than by somebody from their poor community who doesn’t have any medical knowledge but has only a rusty blade…… Yes, everybody could be imprisoned.
— One day I treated a Chinese patient, — she continued with mild sorrow. — Basically, he spoke only Chinese. When I examined him, he pointed out something on a map on a wall and said: “Harbin… beautiful…” As I recognized after that, he had worked as a builder and his partners had beaten and scoffed at him every day. He tolerated it for as long as he could, but one moment arrived when he couldn’t resist and hit one of them on the head with a board. So they imprisoned him…
I thought about it. That situation was unfair and I could imagine how he couldn’t speak in our court, how everybody was opposed to him and how that Chinese man must be desperately homesick. However, such reflections didn’t let me relax because some of my patients were absolutely different.
— Another case, — Olga smiled joyfully, — when I treated one very old and blind man. He was in jail for murder. As it turned out, he had killed his old wife. When I asked him, how he could do it, he answered with a dark grin: “To the touch”… I’m not sure that he didn’t want to strangle me too if he could. I think that we as doctors just have to do what we can to alleviate our patient’s conditions. Of course, they have been punished enough just to be here. You and I —we are not members of a penal system. We were not taught these things. So, sympathize with caution!
My first night duties were waiting in front of me.
To be continued